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Full text of "Navy Department BUMED News Letter Vol. 5, No. 11, May 25, 1945"

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dicjest of tiuxeiij information 

Editor - Lt. Samuel Nesbitt, (MC), U.S.N.R. 

Vol. 5 . Friday, May 25, 1945 No. 11 


Burns: Fluid and Nutrition in 2 Verification Tests in Syphilis 18 

Filariasis: Rehabilitation 10 Thorotrast 19 

Transfusions 11 Excess Property Overseas 20 

Renal Lesions in Casualties 11 Casualty Anuria: Reports on. 20 

Helminthiasis: Epidemiology 13 Bone Infections: Penicillin in 21 

Helminthiasis: Treatment .'......14 Alginate Solution for Dentures 21 

Muscle Hernias in Legs 17 Schwann Cells in Tissue Culture ...22 

Papaverine in Coronary Disease ...18 Erratum 22 

Form Letters: 

Convalescent Hospital, Asbury Park, N.J. SecNav 23 

Alnav 58 - Casualty Reports SecNav 23 

Death Overseas; Care of Remains; Report of Burial BuMed 23 

Prevention of Disease BuMed 27 

Epidemiology Units, Functions of BuMed 28 

Medical Dept. Facilities at NTC, Farragut, Idaho SecNav 29 

Military Government Hospitals, Guam and Tinian SecNav 29 

Alnav 73 - Pratique and Quarantine SecNav 29 

Alnav 413 - Discontinuance of Stock Sl-3531 Plasma SecNav 30 

Alnav 79 - Awarding of Purple Heart SecNav 30 

Roentgenograph^ Examinations of the Chest BuMed 31 

Naval Flight Nurses, Insignia for BuPers 32 

Methyl- Alcohol Poisoning BuMed 33 

BuMed Circ. Ltrs. M-6 and M-7, Modification of BuMed 34 

Partially Disabled Enlisted Men, Policy Regarding JointLtr 36 

Limited-Duty Personnel, Disposition of JointLtr 38 

Chronic Seasickness, Reassignment because of JointLtr 40 

Navy Training Films, Change in Security Classification BuAer 41 

Patient's Identity Tag, Use of .....BuMed 42 

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Burned News Letter, Vol. 5, No. 11 



The Fluid and Nutritional Therapy of Burns: The Subcommittee on Shock 
of the National Research Council has prepared a memorandum, referred to in 
the Burned News Letter of December 22, 1944, containing suggestions for the 
use of fluids and food administered orally and parenterally in the treatment of 
burns. This memorandum was prepared as an aid to the medical officer who 
has had little or no experience in the management of such cases. 

Following damage to the skin by a burn there is loss of extracellular fluid, 
salts arid plasma proteins from the burned area. With this fluid loss there is 
dehydration, a decrease in the circulating plasma volume, and hemoconcentra- 
tion. It is generally agreed that in burns which involve less than 10 per cent 
of the body surface, there is not sufficient loss of extracellular fluid to warrant 
intensive fluid therapy. The following discussion is concerned with patients with 
more than 10 per cent of the body surface involved by second degree (blistered) 
or third degree (coagulated or charred) burns. Roughly, then, this outline 
would be followed for patients with severe burns of at least one of the following 
areas: (1) face and neck, (2) dorsal or ventral surface of chest, (3) dorsal or 
ventral surface of abdomen, (4) one upper extremity, (5) dorsal or ventral sur- 
face of one lower extremity. If there is any doubt as to whether a patient should 
be included in this category, he should be included. Patients with burns involv- 
ing less than 10 per cent of the body surface but having other injuries, particu- 
larly wounds or fractures, also should be included in this category. 

The course of the severely burned and inadequately treated patient can be 
divided into three dangerous phases: 

1. The period of shock (0-48 hours after burn) : The signs of shock are 
often very misleading until just before collapse occurs, and shock may be 
present when apatient appears and acts quite well. Generalized vasoconstriction 
may keep the blood pressure at satisfactory levels even though cardiac output 
is greatly diminished. Therefore, in the early hours, the presence of shock 
is to be assumed in all severely burned patients despite a satisfactory clinical 
appearance. If one waits for the appearance of cold extremities, cyanosis , 
and collapsed veins, therapy is apt to be ineffective. This period of shock 
(0-48 hours after burn) is also the period for intensive fluid therapy. 

2, The period of toxemia (48-120 hours, occasionally as late as the third 
week) : Fever, jaundice, anuria, stupor and delirium, and circulatory collapse 
despite adequate fluid therapy, occur frequently. With full realization of the 
inadequate state of our present knowledge of the cause of burn toxemia, it may 
be helpful to consider it tentatively as due to one or more of the following con- 

(a) Inadequate treatment of shock or treatment not instituted early 
enough, with consequent ischemic damage to kidneys, liver, etc. - for example, 

Burned. News Letter, Vol. 5, No. 11 RESTRICTED 

failure to maintain blood volume by plasma and/or whole blood administration. 
In 'other- instances, loss of electrolytes and fluid from burned surfaces, as well 
as vomiting and sweating with consequent dehydration and acidosis, may be 
etiologic factors. 

Cb) Excessive administration of electrolyte (non-colloid) solutions with 
consequent dilution of plasma proteins to the edema level (less than 5 Gm. pro- 
tein per 100 cc). This is particularly dangerous if there is associated renal 
and /or cardiac damage. 

(c) Infection of burned areas. 

(d) It has been suggested that there is absorption from burned tissues 
of protein products which are "toxic". If this occurs, the effect will be 
minimized by maintaining an adequate blood supply to all the body tissues, i.e., 
a normal blood volume, with normal hemoglobin concentration and adequate 
renal function. 

3. The period of anemia and hvooproteinemia: Anemia and hypoprotein- 
emia may develop during the first 72 hours but are usually not evident until 
the signs of toxicity have largely disappeared. Actual red blood cell destruc- 
tion with hemolysis, hemoglobinemia, and hemoglobinuria soon after the burn 
is a cause of early, masked anemia. It is likely that failure to maintain nutri- 
tion is the most important factor in the production of both anemia and hypo - 
proteinemia , and every effort, therefore, should be made to keep the burned 
patient in nitrogen equilibrium. 

Fluid therapy in burns should be directed toward two major objectives: 
(a) rapid replacement of acute deficits, and (b) maintenance of daily fluid and 
nutritional requirements. Rapid replacement of acute deficits should be di- 
rected toward: (1) restoration and maintenance of a normal blood volume, an 
adequate hemoglobin concentration (13 to 16 Gm. per 100 cc), a plasma pro- 
tein concentration above 6,0 Gm. per 100 cc, a satisfactory urinary output * 
(usually 100 cc. per hour during the first 48 hours); (2) prevention of dehydra- 
tion, acidosis and salt depletion; and (3) avoidance of overadministration o f 
electrolyte (non-colloid) solutions by the parenteral route. 

L Early Acute Burns (0-48 hours) : Fluids are given in this phase for three 
purposes: CI) to restore blood volume and to treat shock (chiefly plasma and 
blood) ; (2) to provide extra fluid to compensate for edema of injured tissues 
and loss from burned surfaces (plasma and salt solutions) ; (3) to provide addi- 
tional fluid for adequate urinary excretion (water and salt solutions or dilute 
salt solutions). In a severe burn (30 to 40 per cent of the body surface or more) , 
the volumes required for. these purposes for the 48-hour period are roughly as 
follows: (1) 2,000 cc; (2) 4,000 to 10,000 cc; (3) 2,000 to 3,000 cc Replace- 
ment therapy in the first 48 hours thus involves fluid volumes of these magni- 
tudes, totaling from 8,000 to 15,000 cc for the 48-hour period. 

Burned News Letter, Vol. 5, No. 11 


A. Intravenous Therapy . 

1. Plasma; Whole plasma is the colloid solution of choice; it supplies 
fluid and electrolyte as well. The dosage of plasma is best gauged by formu- 
lae based on the extent of hemoconcentration, size of burn, and, of special im- 
portance, the clinical response of the patient. It is best not to give all of the 
indicated amount of plasma at one time. Even when shock is severe,- usually 
one -third of the complete dose is sufficient at first, the remainder being given 
during the succeeding four or five hours. 

When acute collapse occurs, the first dose of plasma should be given 
rapidly. Since in these circumstances there is an acute failure of venous re- 
turn to the heart, the fluid introduced must, to a considerable extent, supply 
this venous return. An initial introduction of from 200 to 300 cc. in the first 
two minutes is not too rapid; the administration should be continued, up to 
1,000 cc. or more, until a satisfactory clinical response is obtained. Subse- 
quent amounts should be given more slowly. In shock, time is extremely im- 
portant; if plasma or whole blood is not immediately available, physiologic 
electrolyte solution (two parts physiological saline to one part one -sixth molar 
sodium bicarbonate or one-sixth molar sodium lactate solution) or normal 
saline solution should be administered rapidly until plasma and whole blood 
are secured. Plasma is of little value beyond the third day, and is seldom 
needed after the first 24 hours if the treatment during that period has been 

Representative formulae for computing the amount of plasma to be ad- 
ministered may prove helpful: 

(a) Formulae based on extent of hemoconcentration: 

(1) Give 150 cc. of plasma for each increase in specific gravity of 
0.001 above the normal whole blood specific gravity of 1.060 (i.e., If the spe- 
cific gravity of whole blood is 1.070, give 1,500 cc. of plasma.). 

(2) Or give 100 cc. of plasma for each point the hematocrit exceeds 
the normal of 45 (i.e., If the hematocrit is 60, give 1,500 cc. of plasma.). 

(3) Or give 50 cc. of plasma for each point the hemoglobin exceeds 
the normal of 100 per cent, or 300 cc. of plasma for each gram the hemoglo- 
bin exceeds the normal of 15 Gm. per 100 cc. (i.e., If the hemoglobin is 130 
per cent or 20 Gm. per 100 cc, give 1,500 cc. of plasma.). 

(4) Or give 100 cc. of plasma for each 100,000 the red cell count ex- 
ceeds the normal of 5,000,000 per cu. mm. (i.e., If the red cell count is 6,500, 
000, give 1,500 cc. of plasma.). 

All formulae based on hemoconcentration may at times be in serious error. 
For example, in the first hour or so after the injury, the hematocrit may still 
be normal, plasma loss having just started. In such a case, the hematocrit re- 
peated at the third and sixth hours gives a truer picture of the condition. It 

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Burned News Letter, Vol. 5, No. 11 


should be remembered that formulae dependent upon hemoconcentration show 
only the needs of the patient at the time of testing, not all his requirements 
during the entire course of the burn. The normal plasma protein range i s 
from 6.3 to 7.7 Gm. per 100 cc. with an average of 7 Gm. per 100 cc, which 
latter value corresponds to a specific gravity of 1.0264. 

Hyperproteinemia is not usual. When present, it is encountered only in 
the initial two to three hours and then only in patients who have received no 
fluids and are dehydrated. A hypoproteinemia is the rule. The level may 
fall so low (below 5 Gm. per 100 cc.) that general edema results. If possible, 
the protein concentration should be prevented from dropping below a level of 
6.0 Gm. per 100 cc. (plasma specific gravity of 1.024). 

(b) Formula based on the area Of the burn. 

During the first twelve hours give 50 cc. of plasma for each per cent 
of the body surface involved by a deep (blistering) burn. Often more plasma 
must be given later. Burns of the face, groin, or buttocks usually exude more 
plasma than the surface involvement indicates, and more plasma should be 
given accordingly. Very few persons with burns cove ring less than from lOto 15 
per cent of the body surface will require plasma transfusions. 

2. Albumin: Iso-o.smotic human albumin solution is a satisfactory 
substitute for blood plasma in comparable dosages of protein. With concen- 
trated albumin solutions, saline should be given additionally. 


3. Whole blood transfusions: In patients with a hematocrit below 60, 
give 500 cc. of compatible whole blood for every 1,000 cc. of plasma adminis- 
tered. In any case where plasma is not available, whole blood is better than 
electrolyte solutions. 

Rh typing is mandatory in all burn cases which show transfusion re- 
actions on repeated transfusion. It is desirable in all cases of deep burns of 
more than 20 per cent of the body surface for which repeated transfusions may 
be needed. The use of Rh- negative blood in the cases of females under 40 years 
of age is advisable. (It is advised that regardless of age, all females who are 
Rh negative should be given only Rh- negative blood if it is available. Ed.) 

4. Electrolyte solutions. In burns of less than 10 per cent of the body 
surface, give 2,000 cc. of physiologic electrolyte solution each 24 hours, pref- 
erably by mouth. In burns of more than 10 per cent of the body surface, chief 
reliance for prevention or relief of shock is placed on the use of plasma (or 
albumin or whole blood), as indicated above. Additional amounts of saline and 
glucose solutions should also be given parenterally to those patients for whom 
the required intake by mouth may be excessive, i.e., more than 8 liters in any 

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Burned News Letter , Vol . 5 , ■ No. 11 n - RESTRICTED 

24-hour period. The physiologic electrolyte solution or its equivalent should - 
be used. The fluid should contain glucose, from 100 to 200 Gm. daily. The 
volume of electrolyte solution given intravenously should be roughly the same 
as the volume of plasma given during the first two days. It should b e larger 
or smaller, depending upon the success of oral therapy, but should not exceed 
4,000 cc. in any 24-hour period. 

B. Oral Therapy: As indicated above, oral therapy with crystalloid solu- 
tions is chiefly to replace fluid loss and to maintain adequate urine volume. 
Water and non-salt containing fluids, such as milk and ginger ale, can be given 
up to 2,000 cc. a day to aid renal function; no more than this quantity should be 
given until all of the required electrolyte solution has been swallowed and re- 
tained. After this has been accomplished, water can be given ad libitum. Fruit 
juices, in equal amounts, may serve as a substitute for part of the indicated 
amount of physiologic electrolyte solution. 

In burns of less than 10 per cent of the body surface give 2,000 cc. of physi- 
ologic electrolyte solution during each of the first two days. In burns of more 
than 10 per cent of the body surface give from 3,000 to 8,000 cc. of physiologic 
electrolyte solution the first day, depending on the extent of the burn, and- give 
3,000 cc. of physiologic electrolyte solution the second day. 

Oral therapy should be started immediately on admission, before local 
treatment is begun and while waiting for parenteral therapy to be started. How- 
ever, in severe shock, oral fluids should be started cautiously, as absorption .■ 
may be slow, and there is danger of vomiting and aspiration. In such cases, 
parenteral therapy must be started at the earliest possible moment, and oral 
administration should not be pushed until the patient is out of shock. 

If, after recovery from acute shock, the patient vomits, a quantity of physi- 
ologic electrolyte solution equal to that of the vomitus should be given again. 
If this happens repeatedly, oral fluid should be temporarily discontinued, but 
an attempt should be made to give electrolyte solutions again after a two- to 
three-hour rest period. In cases where the stomach is loaded with food, pre- 
liminary washing out of the stomach to prevent aspiration of solid food may be 
advisable. This procedure may be followed by administration of fluid by Levine 

A definite schedule of oral fluid administration, in terms of cc. per hour 
should be set up and closely followed to avoid overloading the stomach. In 
severe burns, from 200 to 400 cc. of fluid should be given regularly on the 
hour during the first 18 to 24 hours. Usually very large volumes of fluid are 
tolerated during the first two days. Contraindications are: (a) the presence of 
thermal burns of the throat, larynx, or lower air passages (a face burn should 
make one suspicious of such involvement), (b) the presence of the casualty in 

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Burned News Letter, Vol. 5, No. 11 „ , RESTRICTED 

a conflagration in an enclosed space where inhalation of toxic gases may have 
occurred, and (c) the case of the aged or cardiac patient, where too vigorous 
fluid administration increases the tendency to pulmonary edema. A reduced 
parenteral intake of electrolyte solutions and plasma, and the substitution, in 
part, of whole blood, is preferable in such cases. „• 

The urinary output is one important indication of the adequacy of fluid 
therapy. An attempt should be made to maintain the urinary output above 50 cc. 
per hour during the first 48 hours. Obviously, at the beginning of treatment, 
fluids administered will pass into dehydrated and injured tissues, and anuria 
for a matter of hours is not uncommon. With the schedule of treatment already 
described, however, urine output should start at least after four or five hours 
and increase to the 100 cc. per hour level shortly thereafter. An inlying 
catheter may be useful to follow this more closely. It should be realized, how- 
ever, that following shock, especially if prolonged, kidney damage may have 
occurred.' If therapy as described does not open up the kidneys, excessive 
parenteral fluid, especially large quantities of intravenous saline, will not ac- 
complish it either, but will only dilute blood and body fluids. For this reason 
the plasma protein concentration should not be allowed to fall below 5.0 Gm. 
per 100 cc. (plasma specific gravity, 1.021). 

C. Treatment of Acidosis : If the severely burned patient has received no 
fluid therapy for several hours after the time of injury, acidosis occurs not infre- 
quently, particularly if the patient has been in shock for any length of time . Aci- 
dosis should be promptly treated. Normally the C02 content of the plasma is 
about 60 volumes per cent. For each volume per cent the plasma CO2 is under 
55 volumes per cent in a 60 kg. man, give one of the following: 

(1) 40 cc. of a 4 per cent NaHCC>3 intravenously. 

(2) 125 cc. of 1.3 per cent (isotonic) (1/6 molar) NaHCC>3 orally or 

(3) 125 cc. of 1.75 per cent (isotonic) (1/6 molar) sodium lactate oral- 
ly or intravenously. 

(4) 375 cc. of physiologic electrolyte solution (the larger dosage is 
necessary since, to prevent alkalosis when administered in large quantities, 
this solution is purposely made with only one -third the potential bicarbonate, 
and hence only one-third the anti-acidotic power, contained in the 1/6 molar 
solutions) . 

II. Late Burns (after 48 hours) : The chief aims of fluid treatment at this 
stage are the prevention and treatment of toxemia, anemia and hypoprotein- 
emia. If therapy in the first 48 hours has been adequate, a normal intake of 
fluid with supplemental fluid and salt to cover continued loss from the wound 
should prove adequate. After 48 hours some resorption of the local edema 

Burned News Letter, Vol. 5, No. 11 


may be expected, and it may be unwise to force fluids and electrolytes as vig- 
orously as during the period of local edema formation. 

Toxemia may be present early but may cause fatalities as late as the 
third week. Anemia and hypoproteinemia may exist from the first few days 
and are troublesome until granulating surfaces have completely epithelized. 
Electrolytes, as well as protein, are lost from granulating surfaces and should 
be replaced by an adequate intake of salt in the diet. 

A. Intravenous Therapy . 

1. Plasma or albumin is seldom necessary after the second day. A 
transfusion of 500 cc. of plasma usually contains less than 30 Gm. of plasma 
protein; a severely burned patient needs from 150 to 200 Gm. of protein a day. 
Hence, while plasma transfusions are helpful in combating hypoproteinemia, 
they are quantitatively insufficient to accomplish much in this regard. 

2. Amino acid solutions now available can usually be tolerated intra- 
venously in amounts up to from 100 to 150 Gm. of amino acids in a 10 per cent 
solution, if administered slowly. This is helpful during the first week or 
longer (after shock has been relieved) in sustaining and restoring the patient's 
state of nutrition, but is indicated only if the patient cannot take adequate pro- 
teins by mouth. 

3. Whole blood transfusions are of especial value at this stage. There 
is usually a continued red cell loss from bleeding, from increased red cell de- 
struction due to infection, and from failure of adequate red cell regeneration. 
Plasma protein is also lost from open burn surfaces in large amounts. Whole 
blood introduced in large amounts and at frequent intervals combats anemia 
and hypoproteinemia and is one of the best means of maintaining resistance to 
infection. Enough whole blood should be given to raise the hemoglobin to 85 per 
cent (hematocrit to 40, red count to 4.7 millions) and to maintain it at or above 
this level. As much as 1,500 cc. of whole blood daily for several days may be 
given every three or four days as long as the rectal temperature is above 102° 
F., or the plasma proteins are below 6.0 Gm./lOO cc. 

4. Electrolyte solutions administered intravenously are seldom neces- 
sary in the later stages of burns when the patient usually can take sufficient 
fluids by mouth. However , if this is not possible, adequate fluid balance 
should be maintained by the use of intravenous physiologic electrolyte solution 
in adequate, but not excessive amounts. Glucose in saline may be substituted 
for the physiologic electrolyte solution, and at all times a high carbohydrate 
intake (100 to 200 Gm. a day) is advisable. In the presence of infection and low 
blood protein, urine volume may diminish and edema may appear. Strenuous 
forcing of electrolyte solution then may only increase edema. Moderate fluid 
intake , withfeeding and whole blood transfusions, constitutes the logical treatment. 

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Burned News Letter, Vol. 5, No. 11 RESTRICTED 


B. Oral Therapy: The immensely important problem of feeding during 
the often protracted period of infection and anemia cannot be adequately cov- 
ered in this memorandum. Each case is an individual problem of dietetics 
and nursing. A full food intake including calories, vitamins, and especially 
protein, is essential. 

1. Total fluid intake should be sufficient to keep the daily urine vol- 
ume at 1,500 cc. or higher. If salt intake has been adequate, if body proteins 
are not too much depleted, and if heart and kidneys are functionally competent, 
this may require a fluid intake of from 3,000 to 4,000 cc. daily. 

2. Salt (sodium chloride) intake should be maintained at approxi- 
mately 10 Gm. daily, higher if the burn is extensive and if there is much exu- 
date. Too much salt, however, promotes general tissue edema. Blood CO2 
tends to be somewhat low, and administration of some alkaline salt is advis- 
able. The urine should be kept about neutral to litmus. The physiologic elec- 
trolyte solution, from 1,000 to 1,500 cc. daily, will often be useful during the 
first 5 to 10 days. Water can be given ad lib. after the fourth day. 

3. Diet should be high in protein, carbohydrate, calories, and vita- 
mins. In patients with large areas of third degree burns the protein intake 
should be increased as early as possible after the injury and certainly it 
should be increased by the end of the first week. Such protein intake should 
be of the following magnitude: 

5 to 10 per cent body surface burned - 125 Gm. protein per day 
10 to 20 per cent body surface burned - 125 to 200 Gm. protein per day 
over 20 per cent body surface burned - 200 to 300 Gm. protein per day 


The corresponding caloric intake should be approximately 3,000, 
4,000, or 5,000 calories per day. 

(a) An amino-acid preparation by mouth, from 100 to 200 Gm. per 
day, is an effective form of protein intake, but difficult to tolerate because of 
bad taste. Few patients can tolerate it for more than three or four days. 

(b) An example of an adequate diet is the Evans diet, which is palat 
able by mouth but also can be given by gavage: 

150 Gm. dehydrated meat powder 
150 Gm. powdered whole milk 

50 Gm. corn oil 
150 Gm. sucrose 
150 Gm. dextri-maltose 
35 Gm. chocolate 
1,000 Gm. water 
(plus iron and vitamins, especially A, B, C and D.) 


h!;' (c) Adequate vitamins and iron are essential in all unhealed burns. 
A suggested daily dosage in the case of third degree burns covering a 20 per 
cent area follows. Correspondingly smaller doses should be used for less 
severe burns. 

Vitamin A 20,000 units 

Vitamin B 

Thiamin chloride 40 mgm. 

Riboflavin 20 mgm. 

Ca pantothenate 20 mgm. 

Pyridoxine HC1 5 mgm. 

P-aminobenzoic acid 15 mgm. 

Niacin amide 200 mgm. 

Vitamin C 1 Gm. 

Vitamin D 2,000 units 

Vitamin K 1 mgm. 

Ferrous sulphate 3 Gm. 

(Shock Report #57, Feb. 9, '45, from the National Research Council and the 
Office of Scientific Research and Development.) 


Successful Rehabilitation of Filariasis Patients : The naval reconditioning 
center at Klamath Falls has achieved an excellent record in returning to un- 
limited duty status personnel with a history of recurrent filariasis. Personnel 
sent to this station, convalescent from malaria or filariasis, undergo a three- . 
months' program of carefully supervised reconditioning. This is followed by 
a period of intense physical exertion, designed to induce reactivation of latent 
disease processes if at all possible. Only individuals completing the entire 
program without clinical evidence of filariasis are transferred to other duty. 
Under this regime, it has been possible to return virtually all personnel with 
a history of filariasis to unlimited duty in approximately three months. When 
a man is thus transferred, a notation is placed in his health record requesting 
his return to Klamath Falls should a clinical relapse occur. 

Recently a number of individuals have been returned to Klamath Falls be- 
cause of subjective complaints arising at the time of, or immediatelypreceding, 
reassignment to overseas duty. Examination of these men has revealed no evi- 
dence of filarial activity, and it is considered that no basis existed for their re- 
turn to Klamath Falls. Medical officers concerned are therefore cautioned to 
study carefully personnel who present themselves with severe complaints of a 
type usually associated with filariasis, yet who lack objective signs of the dis- 
ease. Strong personal motives may be found responsible for such complaints, 
and the return of such men to Klamath Falls is disadvantageous to the naval 
service and particularly to the program for the rehabilitation of filariasis cases . 

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Burned News Letter, Vol. 5, No. 11 RESTRICTED 

The following may be listed as the criteria for return of individuals 
with a history of filariasis to Klamath Falls: enlarged, tender lymph nodes; 
edema; acute lymphangitis; thickened, tender spermatic cords; epididymitis 
or orchitis when other causative factors for these conditions have been ruled 
out. Lymphadenopathy without inflammation should not be considered evidence 
of an acute attack of filariasis and will be found frequently in individuals i n 
whom filariasis has been entirely quiescent for many months. (Prof. D i v . , 
BuMed - G. C. Thomas) 

^ ?Js *^ *^ 

Transfusions: Whole Blood. Plasma. Serum Albumin: An informal report 
from the Pacific states that the value of whole blood in saving lives can not be 
overemphasized. In one operation over 700 pints were used at the division 
hospital without a reaction. Plasma and serum albumin were used in large 
quantities, especially in the battalion aid stations. Serum albumin is of particu- 
lar value when given early, and it is believed that more of this should be used. 

* * * 


Anuria and Oliguria in Battle Casualties : Reports from activities in vari- 
ous theaters of war, particularly from the U. S. Army in Italy, have indicated 
that a significant number of fatal battle casualties have renal lesions and that 
in a large proportion of these the lesion was extensive enough to have been the 
principal cause of death. Inasmuch as many such patients show hemoglobinuria 
before anuria or oliguria supervenes, or their kidneys at autopsy show tubular 
degeneration and hemoglobin casts, the term "hemoglobinuric nephrosis" has 
been applied to this situation. Certain objection may be voiced to this term as 
nephrosis, in its usual clinical connotation, is not associated with the nitrogen 
retention- which the hemoglobinuric patient almost invariably shows. In general, 
the clinical picture of the latter patient more nearly resembles that of an acute 

Many mechanisms are undoubtedly involved simultaneously in the produc- 
tion of these lesions. Some of these have been shown conclusively to be produc- 
tive of clinical renal damage: 

1. Renal ischemia during profound shock. 

2. Incompatible transfusions in which a donor's cells are agglutinated by 
the patient's plasma. 

3. Sulfonamide crystalluria. 

4. Extensive burns of the body surface. 

Other mechanisms have been found to produce anuria in experimental ani- 
mals, but proof of such involvement in humans is lacking: 

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Burned News Letter, Vol, 5, No. 11 RESTRICTED 

1. Deposition of metamyoglobin from injured muscles. 

2. Deposition of methemoglobin in acidotic animals. 

Finally, still other mechanisms may be involved. They are hypothetical 
and lack clear-cut demonstration in either human or animals, but can not be 
absolutely excluded: 

1. Transfusion of blood which has been stored longer than is permissible 
with a particular diluent, or which has not been properly refrigerated. Examples 
are blood stored longer than 21 days in A. CD. or blood which has been stored 
at a temperature above 20° C. for 24 hours. 

2. Blood transfusions in which donor's plasma agglutinates patient's cells. 

3. Formation and deposition of methemalbumin resulting from the hemo- 
globin liberated by any of the above mechanisms.' 

4. The mercurial preservative which may have been in the transfused 
plasma or albumin. 

The clinical implications of this condition cannot be stated dogmatically. 
It may be pointed out, however, that this general type of renal lesion, even 
when severe, need not always result in death. There is some evidence to sug- 
gest that by proper supportive therapy the patient frequently can be carried 
through the acute phase of renal failure and will recover without residual renal 
injury. In a battle casualty suffering from shock, the renal ischemia parallels 
the degree of shock. To minimize renal injury, prompt restoration of renal 
blood flow is imperative. This may be accomplished best by administration of 
whole blood, plasma, or albumin or a combination of these. With restoration 
of normal blood volume,the greatest stimulus to return of normal renal function 
has been provided. Further assistance may then be given by prompt restora- 
tion of body fluids and electrolyte balance through administration of a solution 
(e.g., 0.6 per cent sodium chloride with either 0.5 per cent sodium bicarbonate 
or 0,6 per cent sodium lactate) which is alkalinizing in its effects. Excessive 
amounts of saline alone, in the presence of renal injury, may wash out bicarbonate, 
as the injured kidney does not retain needed base from sodium chloride as well 
as does the uninjured kidney. Administration of an alkaline solution, on the other 
hand, will correct any existing acidosis, preserve body bicarbonate and increase 
renal blood flow and efficiency of renal function. 

In patients whose kidneys may have already been damaged by a period of 
shock or a course of sulfonamide therapy without sufficient accompanying fluids 
and alkalies, the decision to give a whole blood transfusion should include con- 
sideration of (a) the compatibility of donor's cells and patient's plasma, (b) the 
quality and age of the blood to be transfused, (c) the usefulness of available 
blood substitutes j (d) the prognosis if blood is not given and (e) the severity of 
existing renal damage. It is believed that in most battle casualties suffering 
from severe blood loss, the advantage afforded by the use of whole blood will 

- 12 - 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 

outweigh the risk involved. Nevertheless, it is possible to use whole blood ex- 
cessively, and this vital program should not be abused. When hemoglobin and 
blood volume have been restored through administration of blood or blood sub- 
stitutes, no useful purpose is served by further infusion of blood or its 
fractions. (Nav. Med. Res. Inst. & Nav. Med. School, Bethesda, Md. ; 
E. L. Lozner and L. E. Farr, and S. T. Gibson) 

sf; + sf; sjf jfc 

Epidemiology of Helminth Infestations : Among the medical problems which 
havearisenas a result of war conditions is the increase in helminthiasis. Cer- 
tain infestations which were rarely encountered, such as filariasis and schisto- 
somiasis, are now of major importance. The number of infestations by the more 
common helminths which are cosmopolitan in distribution is increasing wher- 
ever conditions of sanitation are poor. Such infestations may be noted first in 
natives and subsequently be discovered in military personnel. 

The Intestinal Roundworms: Environmental conditions and routes of trans- 
mission are the most important factors in the control of infestation by round- 
worm, Hookworm and Strongyloses are acquired when the parasites in the larval 
stage penetrate the skin; infestation is prevented by avoiding contact with soil 
that has been contaminated by feces. As car is and Trichuris are acquired by 
ingestion of the ova in contaminated food and drink. The ova of both parasites 
require a period of maturation outside the body of the host. Enterobius i s ac- 
quired by ingestion of ova which, in this species, do not require a period of 
maturation. Therefore, this may become a family or group disease as a re- 
sult of carelessness in personal hygiene. 

The Adult Tapeworms: Infestation with Taenia is acquired by the inges- 
tion of improperly prepared meat containing the parasite in the larval stage . 
The larvae will be destroyed in meat by adequate cooking or refrigeration for 
six days at 15° F. The ova of Hvmenolepis are infective when passed and do 
not require maturation; infection results from carelessness in personal 
hygiene. Infestations with Diphvll ob othr ium are acquired by eating raw or 
insufficiently cooked fish which contains the infective larvae. 

Larval Tapeworms : The incidence of infestation with larval tapeworms is 
less frequent than is infestation by intestinal roundworms, adult tapeworms or 
flukes. Although the American Society of Tropical Medicine has recently em- 
phasized the importance of hydatid disease, cases have not been recognized in 
military operations in Australia and New Zealand which are endemic areas . 
Only two larval tapeworms need be considered. Cysticercosis, caused by the 
larval form of Taenia solium , develops following the ingestion of eggs which 
have been passed in the feces of a human harboring the adult worm. The indi- 
vidual may thus infect himself or others through carelessness in personal 

- 13 - 

Burned News Letter, Vol. 5, No. 11 


hygiene. Echinococcosis, due to the larval form of Echinococcus granulosis , 
is acquired by ingestion of eggs commonly present in the feces of the infected 
dog. The sheep is the normal host of the larva, man being accidentally i n - 
fected by handling infected dogs or by ingesting- contaminated food or drink . 
Treatment for these conditions is entirely surgical. 

The Flukes: Schistosomiasis has been discussed in the Burned News 
Letter of January 19, 1945,andinNavMed 642. The most important of the other 
flukes are summarized below. All are found in the Sino-Japanese area and all 
utilize mammals, including dogs and hogs, as the usual definitive host. Snails 
are first intermediate host and fish are the most usual second intermediary 


Lung Flukes: 

Paragonimus westermani 

Liver Flukes: 

Clonorchis sinensis 
Qpisthorchls felineus 
Fasciola hepatic a 

Intestinal Flukes: 

Fasciolousis buski 
Heterophves heterophves 
Metagonimus vokogawai 


Fresh-water crab or crayfish 

Fresh-water fish 
Fresh-water fish 
Aquatic vegetation 

Water plants 

Brackish- and fresh-water fish 
Fresh-water fish 

The prevention of infestation by these flukes depends upon avoiding the in- 
gestion of infested hosts. In endemic areas no fish, shellfish, and water plants 
should be eaten unless adequately cooked. (E. M. Bingham, T. K. Ruebush - 
Nav. Med. School, Bethesda, Md.) 

Treatment of Helminth Infestations : x Although claims of successful treat- 
in ent fqr most worm infestations are legion, there is a certain unanimity of 
opinion as to the drug of choice for each. In order to correlate the most effi- 
cient therapy in respect to the drugs now available, the following table has 
been compiled: 

NEMATODES (Roundworms) 
Trichuris trichiura 

Enterobius vermicularis 


Drug of Choice 

Second Choice 

Gentian violet medicinal Caprokol 

- 14 - 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 

NEMATODES (Roundworms) 
Ascaris lumbricoides 

(large roundworm) 
Ancylostoma duodenale 

Necator americanus 

Mixed ascaris and 

Strongyloides stercoralis 

Trichinella spiralis 

Schistosoma haematobium 

(blood fluke) 
Schistosoma mansoni 

(blood fluke) 
Schistosoma japonicum 

(blood fluke) 
Fasciolopsis buski 

(giant intestinal fluke) 
Other intestinal flukes 

Clonorchis sinensis 
(oriental liver fluke) 

Fasciola hepatica 
(sheep liver fluke) 

Other liver flukes 

Paragonimus westermanii 
(lung fluke) 

Drug of Choice 




Gentian violet 

No specific drug 


Gentian violet 

Emetine hydro- 

Gentian violet 

Emetine hydro- 

Second Choice 


Tartar emetic 
Tartar emetic 



Sodium antimony 

Sodium antimony 

Tartar emetic 

*It is emphasized that, in mixed infestations of Ascaris and hookworm, the 
Ascariasis must be treated first with Caprokol; residual hookworm infestation 
may be treated later with 

CESTODES (Tapeworms) 
Taenia saginata 

(beef tapeworm) 
Taenia solium 

(pork tapeworm) 
Diphyllobothrium latum 

(fish tapeworm) 
Other tapeworms 


Oleoresin of aspidium 
Oleoresin of aspidium 
Oleoresin of aspidium 
Oleoresin .of aspidium 

15 - 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 

All anthelmintics listed under "drug of choice" appear on the Supply 
Table, except oleoresin of aspidium which has been recommended for addi- 
tion to the Table. Seven anthelminthic drugs appear in the Supply Catalog: 

TETRAC HLORETHYLENE , 1-cc. capsule. 

HEXYLRESORCINOL (CAPROKOL), 0.2-gm. in capsule. 

GENTIAN VIOLET, 0.0324-gm. enteric -coated tablet. 


FUADIN, 5-cc. ampule (for parenteral use). 


SANTONIN*, 0.032-gm. tablet. 

*Not recommended as an anthelminthic because of occasional severe toxicity. 

Opinions differ as to the most effective procedure to follow in administer- 
ing each agent. The following methods have been satisfactory in most hands: 

Tetrachlorethvlene: The patient is purged the evening prior to treatment 
with 1 or 1-1/2 ounces of saturated solution of magnesium sulfate. Food is 
withheld on the day of treatment and three 1 c.c. capsules of tetrachlorethylene 
are administered orally. Dosage for children is 3 minims for each year of age . 
Two hours later the patient is purged again, and no food is allowed until the 
bowels have moved. In the treatment of hookworm, expulsion of about 90 per 
cent of the worms can be expected; the few that remain will seldom be suffi- 
cient to produce symptoms if food intake is adequate. Tetrachlorethylene 
routine should not be repeated for at least a week. 

Caprokol (Hexvlresorcinol) : Five 0.2 Gm. capsules are given in the morn- 
ing to the fasting patient without a preliminary purge. Children receive 0.1 Gm. 
per year of age up tb 10 years. Two hours later, a magnesium sulfate purge 
(1 to 2 ounces of saturated solution for adults) is given; food is withheld for 5 
hours after administration of the drug. 

Gentian Violet Medicinal: For Enterobius vermicularis, two 0.0324 Gm. 
enteric-coated tablets are given t.i.d. before meals for 8 days; rest one week, 
then repeat. For Strongvloides stercoralis . and the liver flukes, two 0.0324 Gm. 
tablets are administered t.i.d. before meals for 16 days. Children receive 0.01 
Gm. daily for each year of age. Nausea and vomiting may require temporary 
discontinuation of the drug. 

Oleoresin of Aspidium: This drug is contraindicated in the presence o f 
marked anemia, in pregnancy and .in renal, hepatic and cardiac diseases. It 
is usually dispensed in gelatin capsules containing 0.6 cc. A purge of 1 or 1-1/2 
ounces of magnesium sulfate is given the night before. The following morning, 
the patient is kept in bed and is allowed only water, black coffee or clear tea. 

- 16 - 

Burned News Letter, Vol.' 5, No. 11 RESTRICTED 

At half- hour intervals, three doses of oleoresin of aspidium, 1.2 cc. each are 
administered orally in gelatin capsules. Two hours later the patient is purged 
again, and no food is allowed until a copious bowel movement occurs. Children 
are given a dosage of 1 minim for each year of age up to 12 years. All stools 
passed during the next 48 hours should be carefully examined for the scolex 
of the tapeworm which must be passed before cure is effected. 

Emetine Hydrochloride: This drug should never be administered unless 
the cardiovascular system is normal and there can be careful supervision dur- 
ing the treatment. A dosage of 0.001 Gm. per kilogram of body weight, up to a 
maximum of the 0.0648 Gm. contained in the Supply Table ampule, is injected 
intramuscularly once daily for a maximum of five days. 

Fuadin : This trivalent antimony salt is administered by intramuscular in- 
jection. On the first day 1.5 cc. is given, on the second day 3.5 cc, on the 
third day 5.0 cc, repeating this dosage every other day for seven injections. 
(Prof. Div., BuMed - A. G. Lueck) 

* * * * * * 

Muscle Hernias of Legs: Simon and Sacchet have reported observations 
on 12 patients with muscle hernias of the legs. Three of these patients had 
large solitary hernias of the tibialis anticus muscle, all due to direct trauma. 
In two cases the symptoms were severe enough to justify surgical repair , 
which was successfully accomplished by fascial transplant. Nine patients had 
multiple small hernias which developed spontaneously. Congenital weakness 
was a predisposing factor in some instances. 

Hernia of a leg muscle is characterized as a soft, semifluctuant swelling, 
which increases in size when the limb i s dependent or the muscle is relaxed, 
and which decreases in size or disappears when the muscle involved is 
contracted. It is reducible on pressure when a distinct fascial defect may be 
palpated. There are three types: (1) those due presumably to congenital 
defect; (2) those due to direct trauma, as fractures, lacerations and opera- 
tions, or to indirect muscle violence. These are usually single and 
large and produce symptoms for which surgery is indicated; (3) those of 
idiopathic type, which appear spontaneously, particularly after 
muscular activity is increased. These are usually small, are often multiple, 
present less severe or no symptoms and frequently require no treat- 
ment. Muscle hernias occur quite frequently, especially among young active 
males. Differentiation between mus cle hernias and varicosities is 
often difficult. Other conditions to be differentiated are localized 
varicose veins, lipomata, angiomata and other tumors. 

- 17 - 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 

Surgical treatment, when indicated, consists in reduction of the herniated 
muscle and repair of the defect, usually by fascial transplant or by suture. The 
results are usually good. The authors emphasize the importance of careful 
repair of fascial defects arising from trauma, or after operations, in order 
to prevent later development of hernia. (Am. J. Surg., Jan. '45.) 

ijc g|c $ !(e ♦ 

The Use of Papaverine in Coronary Artery Disease ; Since the very favor- 
able report by Katz on the efficacy of papaverine in large dosage in the treat- 
ment of angina pectoris, Swanson has employed papaverine in treating twelve 
patients with varying degrees of coronary insufficiency. Their ages varied 
from 42 to 74 years. Four of the twelve had angina on effort, but no evidence 
of coronary occlusion that could be determined either from the history or elec- 
trocardiographic examination. Eight patients gave a history sug- 
gesting healed coronary occlusions which had been confirmed by observation 
and/or typical changes in the electrocardiographic pattern. The duration of 
symptoms varied from two months to one year. All of the patients complained 
that their tolerance for activity had been much reduced by the anginal pains ; 
three of them had been bedridden by the severity and frequency of the attacks. 

Papaverine hydrochloride was administered orally in doses of one and 
one -half grains four times daily. Eleven of the twelve patients appeared to be 
definitely improved by the drug. One patient did not show improvement, and 
the administration of the drug had to be stopped because of excessive sleepiness. 
In none of the other cases was oversedation noted as a disturbing side -effect. 
No suggestion of addiction was observed upon cessation of the treatment. 
Two of the bedridden patients were improved so that they could be up sufficiently 
to care for themselves at home, after approximately three and five weeks of 
treatment, respectively. Two of the others who had been forced by their attacks 
to refrain from all manual labor were able to resume light work after one and 
three weeks of papaverine administration. The remainder of the eleven patients 
who improved stated that they had fewer attacks of pain and could walk farther 
as measurement of their improvement. 

Since all of these patients had previously been treated by conventional 
methods, Swanson believes that the high proportion of improvement in patients 
in this small series treated with papaverine is significant. (J. Lab. & Clin. 
Med., April '45.) 

?|c 3^C j|c )jc j(t 3)t 

Verification Tests in Serodiagnosis of Syphilis : The verification test in 
serodiagnosis of syphilis was noted in the Burned News Letter of August 20, 
1943. Rein and Callender have reviewed the literature concerning the several 

Burned News Letter, Vol. 5, No. 11 


methods developed for the differentiation of true and false-positive reactions 
in serologic tests for syphilis. They are of the opinion that the average sero- 
logist has not been able to distinguish consistently between true and f alse - 
positive reactions by the use of any verification test yet devised, that for the 
present these tests should be considered as being in the experimental stage 
and that further investigative work on the subject is necessary. At present, 
the final diagnosis of a syphilitic infection in doubtful cases should depend on 
the ensemble of available data, including (1) history, (2) physical examination, 
(3) radiologic examinations of the heart and aorta, (4) spinal fluid examination, 
(5) examination of contacts, marital partners, brothers and sisters, and (6) re- 
peated serologic examinations in the same and other laboratories. Additional 
laboratory examinations should be made, including blood counts, blood spreads, 
heterophil antibody tests, sedimentation rates, complement-fixation tests, 
precipitation and agglutination tests, and albumin- globulin ratio studies, in 
order to rule out non- syphilitic diseases which may cause false-positive sero- 
logic reactions. 

The following requirements are setup as criteria of the value of any veri- 
fication test intended for routine use: 


1. Sera from syphilitic individuals with positive serologic tests should 
always give a syphilitic type of verification reaction. 

2. Sera from non- syphilitic individuals with positive serologic tests should 
always give the false -positive type of verification reaction. 

3. The diagnosis of syphilis should be established in persons who consis- 
tently give the biologic false-positive type of verification reaction on repeated 

The conclusion is stated that any new verification test should be subjected 
to critical evaluation by independent workers before it is adopted as a routine 
procedure for the differentiation between true and false -positive serologic re- 
actions. (V. D. Information, April '45) 

- sjc sjt sf; 

Thoyotrast (Thorium Dioxide) : The discovery that thorium is retained by 
the liver when thorotrast is administered intravenously has 1 e d to its use by 
roentgenologists as a means of visualizing lesions of the liver. 

However, the possibility that the radioactivity of thorium may produce 
radiation injuries to the liver has averted a wide use of this method. 

Detailed studies by Stenstrom in 1941 indicate that, while there is some 
excretion of the radioactive* decay products, thorium is retained indefinitely. 
Although individuals given thorotrast eight years ago still show no ill effects 

- 19 - 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 

attributable to it, radiation injuries are notoriously slow in appearing. It fol- 
lows, therefore, that a most conservative attitude is still appropriate regard- 
ing the use of thorotrast. (C. F. Behrens, Nav. Hosp., Bethesda, Md.) 

Reports of Excess Property from Overseas Activities : Many Medical 
Department activities located beyond the continental limits of the United 
States continue to report excess property to the Materiel Division, Bureau of 
Medicine and Surgery, for disposal or redistribution. Property Disposition 
Directive No. 6, Revision No. 1, dated 17 January 1945, outlines the method of 
handling excess property at such stations. The method now in force for the 
disposition of excess property overseas is to report this property to the Area 
or Force Commander who will decide whether or not the material is needed 
elsewhere within the area or force. The Materiel Division returns reports of 
excess property which are received from activities located beyond the conti- 
nental limits of the United States without acting upon them. Loss of time may 
be avoided by employing the proper procedure. (Mat. Div., BuMed - K . C . 


Informati on Needed on Oliguria in Battle Casualties : According to recent 
reports from the field, some severely injured men develop oliguria or anuria 
from 8 to 12 days after injury. This follows a brief period of apparent clinical 
improvement and recovery from shock. The importance of renal damage in 
battle casualties and the probable mechanisms involved have been discussed 
on page 11 of this issue. It is apparent that more information on the problem* 
is needed. Medical officers in the forward areas are therefore urged to make 
the following contributions whenever possible: 

1. Brief reports addressed to BuMed, giving essential data on cases of 
post-traumatic oliguria or anuria with reference to: (a) severity and type of in- 
jury; (b) administration of whole blood, plasma and albumin (amounts of each 
used); (c) use of sulfonamide, if any; (d) interval between injury and onset of 
oliguria; (e) therapy used in treating oliguria; tf ) outcome. 

2. Sections of the kidneys of fatal cases prepared and shipped to 
MedOfCom, Naval Medical School, National Naval Medical Center, Bethesda, 
Maryland, in accordance with the detailed instructions of BuMed ltr A11/P3- 
4(041) dated 15 April 1943, and reprinted in Burned News Letter of 30 April 
1943. In fatal cases, the clinical history and autopsy protocol should accom- 
pany the specimen in the mailing container; in these instances it will be un- 
necessary to send a separate report to BuMed. 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 

Penicillin Treatment of Bone Infections ; A discussion of the penicillin 
therapy of chronic osteomyelitis appeared in the Burned News Letter of 
January 5, 1945. Naffziger et al have reported a study of 46 patients who had 
infections involving bone and who were treated with penicillin intramuscularly 
or locally or by both methods. Prolonged systemic treatment with penicillin 
(from 3 to 8 weeks) often was needed to control infections involving the bone. 
Prompt recurrence of infection occurred in several cases in which shorter 
periods of treatment were used. Contamination of wounds with penicillin- 
resistant organisms appeared to prolong drainage but did not prevent heal- 
ing when the predominant pathogenic organism was sensitive to penicillin. In 
some cases evacuation of well localized abscesses by aspiration, followed by 
local instillation of penicillin, was preferable to incision with drainage. Sys- 
temic penicillin therapy appeared to be the most important factor in control- 
ling infections of bone, but the control of infection and healing appeared to 
be much more prompt in cases in which the zone of infection was accessible 
to supplementary local treatment with penicillin. (OEMcmr-431 - Naffziger 
et al, Univ. of Calif. - CMR Bulletin #22) 

The Use of "Alginate Solution" in Denture Work : The present supply of 
tin-foil for use in processing denture bases contains seventy per cent lead. 
The fact that lead reacts with monomeric methylmethacrylate accounts for 
the fact that denture bases discolor after a short period of use. This tin-foil 
is undesirable also because it is not nearly as malleable as was the former- 
supply. In adapting it to casts it tears easily, and it cannot be burnished suf- 
ficiently to eliminate folds. Thus, it would seem desirable to replace the tin- 
foil formerly standard for use in the Naval Dental Corps. Most foil substitutes 
in the form of different types of solutions, have not proved themselves of suf- 
ficient value for adoption. 

These facts led to an investigation of the most efficient manner in which 
to use the "Alginate Solution" now available on the Supply Table (Navy Dental 
Stock No. Si 1-005). The results of this study indicate that the proper use of 
this solution may result in more satisfactory work and greater efficiency in 
prosthetic dentistry in the Navy. 

It is known that cellophane alone was an undesirable covering for a cast 
during processing of denture bases. It caused wrinkles to appear in the bases, 
and it did not permit the material to flow freely into the deep peripheral areas 
of the cast. This caused a shortened or under -extended periphery in the den- 
ture base. It has been noted that for convenience in test packing, deep periph- 
eral areas are sometimes packed separately from the saddle areas. The 
cellophane used in testing them separated the periphery from the rest of the 

- 21 - 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 

base. Even in cases where the periphery and saddle areas could be packed 
together, undesirable wrinkles still appeared on the surface of the finished 
denture base. This was due to the fact that, under pressure, the cellophane 
would not slip to an even contour on the dry base. 

A case was processed using a combination of cellophane and the alginate 
solution; the usual amount of alginate in the solution was doubled. After the 
case was cured, it was opened and the cellophane easily removed. The tissue 
surface of the denture base was as highly polished and free from wrinkles as 
though high-grade tin-foil had been used. The adaptation to the peripheries 
was equally successful. 

There is no need to refinish or polish the peripheries since accuracy in 
these areas is obtained by this method. (Nav. Dental School, Bethesda, Md. - 
L. W. Colton and L. W. Harris) 


Behavior of Schwann Cells in Tissue Culture : Observations have been made 
on the behavior of Schwann cells during culture of more than 1,000 nerve frag- 
ments from rats. The free Schwann cells undergo characteristic transforma- 
tion depending on the ultrastructural configuration of the medium. Along linear 
(fibrous) surfaces they remain filamentous, a shape predisposing them to serve 
as guides for axons. Along planar surfaces, they are transformed into typical 
macrophages by three alternative modes, all of which lead to an ameboid, mi- 
totically active and highly phagocytic cell. These transformations, which have 
been observed in many thousands of cells, indicate that the majority of macro- 
phages appearing in distal nerve stumps during Wallerian degeneration are, in 
reality, transformed Schwann cells. Their active participation in the ingestion 
and digestion of myelin fragments has been proved by observation of the living 
cultures. (OEMcmr-221 - Weiss and Wang, Univ. of Chicago. Ms. for publica- 
tion. CMR Bulletin #22) 

Erratum: Metric Equivalents : In the Burned News Letter of May 11, 1945, 
on Page 12, Column 2, 3/4 grain - 16 milligrams (mg.) should read 1/4 grain - 
16 milligrams (mg.) 

Burned News Letter, Vol. 5, No. 11 


To: All Ships and Stations. Opl3-lD-psp 

Serial 148413 

Subj: U. S. Naval Convalescent Hospital, Asbury Park, 3 19 212 

New Jersey - Establishment of. 31 Mar 1945 


1. The facilities of the former U. S. Naval Reserve Premidshipmen's School 
at Asbury Park, New Jersey, have been transferred to the Bureau of Medicine 
and Surgery for hospital purposes and are hereby established and designated: 

U. S. Naval Convalescent Hospital 
Asbury Park, New Jersey. 
This is an activity of the Third Naval District. 


2. Bureaus and offices concerned take necessary action. 

--SecNav. James Forrestal. 

* * * * * * 


Subj: Casualty Reports. BuMed. 31 Mar 1945 

Alnav 162-42 hereby amended. Original dispatches from ships and stations 
within continental United States reporting deaths shall contain all information 
required by article 908(2), Navy Regulations. 

--SecNav. James Forrestal. 

To: All Ships and Stations. BuMed-C-LET 


Subj: Deaths Overseas; Care of Remains; Report of Burial. 26 Feb 1945 

End: (A) Copy of Report of Burial (NavMed 601) . 


1. The return from overseas of all Army, Navy, Marine Corps, Coast Guard 
and civilian dead, upon cessation, of hostilities, will be the responsibility of 
the Graves Registration Service of the U. S. Army Service. Force. It is desired 
that all naval activities shall cooperate fully with that Service. 

2. To provide the Army Graves Registration Service with accurate records of 
burials of all military or civilian dead buried by Navy, Marine or Coast Guard 
personnel, it is directed that NavMed Form 601 (Report of Burial) be submitted 
in triplicate (additional copy for allied and enemy dead) to the Bureau of Medi- 
cine and Surgery in all cases of burial at sea or burial or reburial ashore be- 
yond the continental limits of the United States, including Alaska. 

Burned News Letter, Vol. 5, No. 11 


3. In addition to NavMed Form 601, officers in charge of Navy, Marine Corps 
and Coast Guard cemeteries beyond the continental United States, including 
Alaska, are. directed to forward to the Bureau of Medicine and Surgery: 

(a) A letter report, in duplicate, of all burials to date, giving name and 
location of cemetery, full name of deceased, file or service number (if known), 
rank or rate, organization, date of burial, and plot, row, and grave number. 
Burial of unidentified remains shall be reported as unidentified, and assigned 

' consecutive numbers with a prefix "X" (e.g., X-l, X-2, etc.). This "X" num- 
ber will be used in all correspondence regarding burial. Cemeteries where 
burials were made prior to 7 December 1941 shall list only those buried sub- 
sequent to 7 December 1941. 

(b) A monthly report, in duplicate, listing all burials since previous report, 
giving information as listed in paragraph 3 (a) . 

(c) A map or blueprint of cemetery, in triplicate. Enter name of person 
buried in each grave. Number consecutively all graves, including those in which 
no burials have been made, and provide space for entry of names after records 
of burials are received in the Bureau. 

(d) Letter report giving following information: 

(1) Is cemetery land government-owned or leased, and what is acreage 

(2) If leased, is there a clause requiring perpetual care? 

(3) What medical activity is charged with responsibility for maintenance 
and upkeep, and what is distance from cemetery? 

4. All efforts should be made to avoid isolated burials. In case of isolated 
burials, the grave shall be well marked, map prepared giving location of grave, 
and proper authorities notified, so when conditions warrant, the remains may 
be removed to the nearest appropriate cemetery. NavMed Form 601 shall be 
prepared for both original burial and reburial. 

5. A supply of NavMed Form 601 will be furnished when received from the 
printer, without requisition, to all ships and stations outside of the continental 
United States, including Alaska. Additional supplies are to be requisitioned 
from the naval medical supply depots in the usual manner (Stock No. SI 6- 90 5; 
NavMed No. 601; Item: REPORT OF BURIAL; Unit: 50 in pad). In an emergency, 
a supply of War Department QMC Form 1042 (Report of Interment) , which is 
similar, may be obtained from the nearest Army quartermaster depot or grave 
registration unit. Pending receipt of the initial supply, the form shall be repro- 
duced locally as far as practical, as illustrated by enclosure, and reporting of 
burials started immediately. 

6. War Department Technical Manual 10-630 (TM 10-630), War Department 
Technical Bulletin- 10-630-2(TB 10-630-2) and Army Regulations No. 30-1810 
(AR 30-1810) contain information and instruction for Army grave registration 
units. These publications may be obtained from the nearest Army quartermas- 
ter depot or grave registration unit. --BuMed. W. J. C. Agnew. 

- 24 - 


NAVMED — 60 1 (3-J5) 

INSTRUCTIONS.— Forward original and two copies far U. S. dead (additional copy for allied and enemy dead) to BuMed on all burials or 
rebvriats beyond the continental United States, including Alaska, or at sea. In the field, armed guard crews, etc., forward through head, 
quarters or activity carrying records, for checking with casualty reports. 

If any of the required facts are unknown, so state. List only personal effects found on the body. In burial at sea, give areas as — Hawaiian, 
Alaskan, etc. Assign consecutive numbers with a prefix "X" to all unidentified remains. This "X" number shall be used in all corn- 
spondence regarding burial. 

^aSh^W of o 6A th _ - - D SEJFS5? 


NAME <L™0 (firs!) fiddle) 























□ 1 Q I □ NONE 


(Identification cards, letter*, etej 


□ «*• n »° 


□ Y» □ N. 




□ »•» n »■ 



Bodies Buried an Either Side 

BODY ON LEFT, NAME {Last, first, middle) 




BODY ON RIGHT, NAME (Last, first, middle) 




PERSON REPORTING BURIAL (Name) (Bank or rate) 




(Name) fR*3T ~ "™ (Title) 


3 3 

a 3 



O 3 


ISOLATED BURIALS. Have body examined to establish IDENTITY. If body is unidentified, take 
four (4) sets of fingerprints of all available fingers. Complete the following: 








(If actual weight and height are used, delete estimated) 

Wrap and tie body securely in a blanket, pad covering, canvas or other suitable substance. Dig grave 
to five feet or in hasty -burials, to sufficient depth to prevent destruction of body or loss of identity. Place 
only one body in grave. Securely fasten one identification tag to body. Remove other identification 
tag and attach to grave marker (when body is disinterred or properly recorded, remove and forward 
to BuPers, Marine Corps, or Coast Guard, as indicated). If no tag. is present, make a notation with 
pencil of identifying data on form in duplicate, place in bottle, canteen, spent shell or other available 
container which can be made watertight, bury one with remains and the other, one (1) foot below grave 
marker. If no tag is available, write identifying data on marker. When pegs are not available, use other 
suitable means to identify grave as a military grave. 

2. LOCATION OF GRAVE: Report burials in established cemeteries by plot, row, and grave number. 
For all other burials, prepare sketch in space provided below; and give location by means of map refer- 
ences, or by reference to prominent, permanent landmarks. Information must be specific, accurate, 
complete. Stand at foot of grave facing head to determine bodies buried to the left and right. 

If the body Is otherwise unidentified or fingerprints unobtainable, chart the 
dental conditions tn conformity with Instructions in M M D (1942, 1938-43 Ed. ^£ * S 
para. 2318 CM 0) & (2))(1945 Ed. para. 2234.1 & .2). This must be accurals, - ■ ■ u 1 » "- 

CHARTING EXAMPLE: (Chart Cavities In BLACK; otherwise use RED) 
Tootn No. 1 , missing; No. 2, gold Inlay and two silver fillings; No. 3. full gold 
crown; No. 4, cavity; No.5,two porcelain or temporary fillings ; Nos. 6. 7, 8. gold 
fixed bridge supplying missing tooth No. 7; No. 9, porcelain crown (outlined). 


Missing teeth" Nos. 

Occlusion (JVjko/j 

Malposed teeth (Describe) _ 

Removable appliances , 

Other defects 

CH££K si foe 




{Signature of denial examiner) 

(Rank or rate) 


- 26 - 

Burned News Letter, Vol. 5, No. 11 


To: All Ships and Stations. BuMed-A-EC 
Subi: Prevention of Disease. 31 Mar 1945 

1 . All medical officers are directed to pay special attention to the prevention 
of disease and to the constant exercise of communicable- disease control meas- 
ures, and are cautioned against lessening their responsibilities toward disease 
prevention by depending too much upon the use of sulfonamide drugs, penicillin, 
the control of bacterial content of the air by glycol vapors and ultraviolet, use 
of DDT, and upon other new outstanding advances in medicine. ■ 

2. The establishment of epidemiology units, malaria- control units, and other 
special hygienic and public-health activities must in no manner be considered 
as relieving medical officers of any responsibility in disease prevention. 

3. Senior medical officers of all Navy and Marine Corps activities to which 
large numbers of personnel are attached are directed to utilize epidemiology 
units for the purpose for which they were created, and in addition thereto to 
assign the senior medical officer member of this unit or, in the absence of such 
a unit, an experienced medical officer to special duty in charge of prevention 

of disease measures on the station, responsible to the senior medical officer. 

4. Attention of all medical officers is invited to the following factors which, 
if disregarded, might be responsible for the spread of communicable diseases: 

(a) Overcrowding. 

(b) Proper spacing of beds. 

(c) Head-to-foot sleeping. 

(d) Proper dust control in cleaning wards, barracks, and compartments. 

(e) Proper care and sterilization of bedding, including mattresses. This 
should include periodic airing and sunning. 

(f) Maintenance of high standards of mess sanitation with great emphasis 
on food handling and mess -gear sterilization. 

(g) Periodic physical examination of food handlers. 

(h) Periodic sanitary inspections. 
Ci) Proper refrigeration. 

(j) Proper disposal of wastes. 

(k) Periodic bacteriological examination of water and dairy products. 
(1) Proper safeguards against transmission of insect-borne diseases. 

5. The professional awareness toward being constantly alert to the part played 
by 1 'carriers" in the transmission of certain diseases, and to the other factors 
which are known to have caused epidemics is of paramount importance. 

6. In hospitals, dispensaries, and sick bays, constant vigilance must be exer- 
cised to insure that the recognized measures for the prevention of cross infec- 
tions (respiratory, wound, etc.) are applied at all times. 

- 27 - 

Burned News Letter, Vol. 5, No. 11 RESTRICT 

7. A pamphlet for the use of Medical Department personnel in which the im- 
portance of all simple measures definitely contributing toward the control of 
communicable disease is in the process of preparation. Medical officers are 
directed immediately to make every effort to prevent disease and not delay 
action or recommendation to commanding officers until this publication is 
received. --BuMed. Ross T. Mclntire. 


To: All Ships and Stations. BuMed- Y-HS 


Subj: Epidemiology Units, Functions of. 13 Apr 1945 

1 . Information received in this Bureau indicates that the functions of epidem- 
iology units are not fully appreciated and that their special training is not 
always used effectively. 

2. It is intended that personnel in these units be used for the prevention and 
control of disease and not for general assignments except in extreme emergencies 

3. Epidemiology units were created and strategically placed to supplement 
local medical activities in solving problems in preventive medicine. It is also ex 
pected that they shall work in close association with the Navy Commissary and 
Public Works Departments, the U.S. 'Public Health Service, military agencies, 
and the health departments of various States, cities, Territories, and foreign 

4. The personnel of these units are especially trained in preventive medicine 
and sanitation. This training equips them to render invaluable services in: 

(a) Investigation of outbreaks of communicable diseases. 

(b) Surveys for disease vectors and human carriers of respiratory and 
enteric pathogens. 

(c) The sanitary control of food, water, waste disposal, living quarters, 
swimming pools, and bathing sites. 

(d) General sanitary inspections and surveys. 

(e) Dairy inspection and testing of milk and other dairy products. 

5. The most important function of epidemiology units is the prevention of 
epidemic conditions. 

6. It is the desire of this Bureau that maximum use be made of the epidemio- 
logy units in the field of preventive medicine. These units are to be immedi- 
ately available for special epidemiological investigation at naval activities 
upon the recommendation of the Bureau or upon request to the district com- 
mandant or area commander. --BuMed. W. J. C. Agnew. 

W ^ *^ % ^ sfc 

- 28 - 

Burned News Letter, Vol. 5, No. 11 

To: All Ships and Stations. Opl3-lD-psp 

Serial 212813 

Subj: Medical Department Facilities at the Naval Training 

Center, Farragut, Idaho. 19 Apr iy4t) 

1. The facilities of the Naval Training Center, Farragut, Idaho, known as 
Camp Bennion, including the land, buildings and equipment constituting such 
camp, are hereby transferred to the U. S. Naval Hospital, Farragut, Idaho. 

2 Bureaus and offices concerned take necessary action. 

--SecNav. James Forrestal. 

* * * * 


To: All Ships and Stations. ^ld-lD-psp 

Serial £16916 

Subj* U. S. Naval Military Government Hospitals, No. 203 

Guam and No. 204 Tinian - Establishment of. 25 Apr 1945 

1 The Military Government medical facilities for the care of civilians on 
Guam are hereby established under a medical officer in command and desig- 
nated as follows: 

U. S. Naval Military Government Hospital No. 203, Guam, Marianas Islands. 

2. The Military Government medical facilities for the care of civilians on 
Tinian are hereby established under a medical officer in command and desig- 
nated as follows: 

U. S. Naval Military Government Hospital No. 204, Tinian, Marianas Islands . 

3 Bureaus and offices concerned take necessary action. 

SecNav. James Forrestal. 

ALNAV73 BuMed 18 Apr 1945 

Subj: Pratique and Quarantine 

New U S Public Health Service regulations do not require a vessel which has 
been given free pratique in Alaska, Territory of Hawaii, Puerto Rico or Virgin 
Islands to clear quarantine upon arrival at any other port of the continental 
United States, its Territories, or possessions. Such ships are subject only to 
coastwise regulations provided they have not entered a foreign port after re- 
ceiving pratique . -SecNav. James Forrestal. 

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Burned News Letter, Vol. 5, No. 11 RESTRICTED 

ALNAV 413 BuMed 24 Apr 1945 

Subj: Discontinuance of Stock SI -35 31 Plasma. 

The use and issue of stock number SI -3531 Plasma Normal Human Dried 
500 cc pkg. manufactured by Sharp and Dohme, lot number 288395, expiration 
date March 1947, shall be discontinued immediately pending investigation and 
instructions. --SecNav. James Forrestal. 


ALNAV 79 BuPers 26 Apr 1945 

Subj: Awarding of Purple Heart. 

Refs: (a) General Order 186, of 21 Jan 1943. 

(b) Alnav 26-44; AS&SL Jan-Jun 1944, 44-78, p. 95. 

It has come to the attention of the Navy Department that numerous cases 
have occurred wherein an undue interval of time has elapsed between the pres- 
entation of the Purple Heart and the incident for which it is awarded. To ob- . 
viate this, fleet commanders are hereby authorized to delegate authority to 
award the Purple Heart to commanding officers of such hospital ships, advance 
bases, or other hospitals within their commands as they may deem necessary 
for this purpose. 

Authority to award the Purple Heart is hereby delegated to commanding of- 
ficers of all hospitals within the continental limits of the United States or 
otherwise not under the command of forces afloat. 

It is considered that General Order No. 186 and other instructions amply 
provide for the prompt award of the Purple Heart to personnel who are not 
transferred to a hospital or hospital ship by reason of injuries warranting the 

Immediately upon the arrival of a patient, whose diagnosis or accompanying 
documents or other circumstances indicate that he is entitled to the Purple 
Heart, at a hospital ship or other hospital whose commanding officer is author- 
ized to make the award, such commanding officer will ascertain from the pa- 
tient, accompanying documents, or other means available whether or not the 
patient has received his Purple Heart and, if not, make the award and presen- 
tation. Suitable entry will be made on records accompanying the patient. Each 
award will be accompanied by a certificate stating that the award is made by 
authority delegated to the awarding authority and giving the date of injury and 
general geographical location where received. 

For the purpose of proper record keeping in the Navy Department each of- 
ficer having authority to award the Purple Heart will forward on the last day 
of each month, in triplicate, to the Bureau of Naval Personnel, the Commandant, 

- 30 - 

Burned News Letter, Vol. 5, No. 11 


United States Marine Corps, and the Commandant, United States Coast Guard, 
as appropriate, a list of Purple Hearts awarded showing full name and rank or 
rating of recipient, the date of award, date of injury, character of injury, and 
general geographic location in which injury was received. Additional copies 
will be forwarded as fleet commanders may direct. 

Fleet commanders will issue necessary instructions to avoid duplication of 

The policy set forth in reference Cb) will continue as the basis for the award 
of the Purple Heart. Posthumous awards will continue to be made and for- 
warded to the next of kin by the Navy Department. 

Conflicting portions of General Order No. 186 are hereby canceled. 
Fleet commanders will furnish commanding officers to whom authority is 
delegated in accordance with the above with a supply of Purple Heart medals. 

The Bureau of Naval Personnel will furnish such hospitals within the con- 
tinental limits of the United States as are designated by the Bureau of Medicine 
and Surgery with a supply of Purple Hearts. — SecNav. Ralph A. Bard. 

To: All Ships and Stations. BuMed-RP-MDM 

Subj: Roentgenographic Examinations of the Chest of 

Certain Officer Personnel upon Reporting for 26 Apr iy4o 

Active Duty. 

Ref: (a) BuMed ltr BuMed-Y-DFS, P3-3/P3-1 (054-40) , of 4 Jan 1945; 
N. D. Bui. of 31 Jan 1945, 45-83. 

1 Paragraph 2 of the reference directive states in part that "Roentgenographic 
examination of the chest shall be made as a part of the physical examination 
to determine physical fitness for original entry into the service and for active 
duty". It has come to the attention of this Bureau that the roentgenographic 
examination cannot be obtained for approximately one-third of the applicants 
for appointment and commission at the time they are processed in the offices 
of naval officer procurement. The responsibility, therefore, for obtaining sub- 
ject examination in these cases rests with the medical officer who examines 
such individuals to determine their physical fitness for active duty. In the 
event such medical officers are unable to obtain chest X-ray in the cases of 
officer personnel at the time they report for active duty they shall, provided 
the officer has not had a recent chest X-ray, make the following entry on a 
NavMed Form H-8 (Medical History Sheet) in the health record of the officer 

N Reference: BuMed ltr BuMed- Y-DFS, P3-3/P3-K054-40) dated 4 

O Jan * 

T Chest X-ray study has NOT been conducted in this case. It is to be 
E conducted at the first opportunity and a report thereof forwarded to 
the Bureau of Medicine and Surgery. 

--BuMed. Ross T. Mclntire. 

- 31 - 

Burned News Letter, Vol. 5, No. 11 



To; All Ships and Stations. Pers-329-GL 


Subj: Naval Flight Nurses, Insignia for. 30 Mar 1945 

Ref: (a) U. S. Navy Uniform Regulations, 1941. 

Encl: (A) Photograph of insignia for naval flight nurses. 

1. The Secretary of the Navy has approved an insignia for naval flight nurses, 
as shown in enclosure (A). Reference (a) therefore will be corrected as follows: 

After article 9-53 add a new heading and paragraph as follows: 


9-54. Aviation Insignia, Naval Flight Nurse. --Nurses who have been desig- 
nated as Naval Flight Nurses shall wear the following insignia: 

Gold-plated metal pin, winged, with slightly convex oval crest with appro- 
priate embossed rounded edge and scroll. The central device shall be sur- 
charged with gold anchor, gold spread oak leaf and silver acorn, symbol of 
the Nurse Corps insignia. The metal pin shall be of dull finish. The insignia 
shall measure 2" from tip to tip of the wings; oval crest 9/16" in vertical 
dimension and 7/16" in width; oak leaf 13/32" in length, 7/32" in width, to 
be diagonally mounted surcharged on the anchor; silver acorn 1/8 "in length 
surmounted on oak leaf. 

The above insignia shall be worn until the designation "Flight Nurse" is re- 
cked. --BuPers. L. E. Denfeld. 


- 32 - 

Burned News Letter, Vol. 5, No,. 11 


To: All Ships and Stations. P3^/^~]l7 DEC 
Subj: Methyl- Alcohol Poisoning. 19 A P r 1945 

1 Despite precautions taken to safeguard against poisoning from methyl (wood) 
alcohol, death, blindness, and other disabilities among naval and Marine Corps 
personnel have increased sharply during 1944 as. a result of drinking this 
poison In view of the extremely toxic character of methyl alcohol, and the ten- 
dency to confuse it with ethyl (grain) alcohol, the most vigorous efforts to pre- 
vent this type of poisoning must be undertaken. 

2. Methyl alcohol, known also as methanol, or as wood alcohol (obtained by 
the destructive distillation of wood) , is colorless and has an odor and taste 
similar to that of ethyl alcohol. It is commonly used as duplicator fluid, canned 
heat," paint thinner, cleaner and as an antifreeze. 

3 Methyl alcohol can enter the body by any of three ways: (1) By inhalation of 
the vapor, (2) by absorption through the skin, and (3) by swallowing. Of these, 
the last far outweighs either of the others as a cause of disability or death. 
One to five ounces taken internally can cause death and one -half to two ounces 
can cause permanent total blindness. Repeated ingestion of small amounts has 
a cumulative effect upon the internal organs, and may ultimately lead to death 
or blindness. In handling methyl alcohol care must be taken to avoid breathing 
heavy concentrations of the vapors, and to avoid contact of methyl alcohol with 
the skin. 

4. Deaths have occurred in the Pacific from the use as a beverage of Japanese 
methyl alcohol by U. S. naval and Marine Corps personnel. The containers of 
such methyl alcohol are labeled only in Japanese, or may be deliberately mis- 
labeled in English. Under no circumstances should such material be taken 

5. It is recommended that the following precautions be taken by all ships and 
stations in handling, storing, issuing and using methyl alcohol: 

(a) Make clear to all naval and Marine Corps personnel the distinction be- 
tween methyl alcohol and ethyl alcohol. Methyl alcohol is a dangerous poison 
and must be handled as such. 

(b) Maintain a close inventory of all pure methyl alcohol and any commer- 
cial product containing methyl alcohol. Release for use only the amount re- 
quired, and at the time needed, to perform a specific job. 

(c) Whenever possible substitute other less toxic solvents for methyl alco- 
hol or products containing methyl alcohol. 

(d) Add to methyl alcohol, if practicable, an ingredient such as ethyl mer- 
captan, kerosene, or white gasoline to give a disagreeable odor and taste which 
will discourage persons from using it as a beverage. The addition of kerosene 
or white gasoline in amounts of 0.5.% will have the desired effect, and will not 
alter the properties of methyl alcohol as a cleaner, paint thinner or antifreeze. 

- 33 - 

Burned 'News Letter, Vol. 5, No. 11 RESTRICTED 

(e) Require a prominent label to be affixed to all permanent or temporary- 
containers of methyl alcohol, or products containing methyl alcohol, as follows: 


6. All persons charged with custody, inventory, issue and use of methyl alco- 
hol should familiarize themselves with the contents of this letter. 

--BuMed. Ross T. Mclntire. 

To: All Ships and Stations. BuMed-MH6-SEH:RLS 


Subj: BuMed Circ. Ltr M-6, Receipt, Transfer, and 

Disposition Card (NavMed HC-3),and BuMed 21 Apr 1945 
Circ. Ltr M-7, Roster Report of the Hospital 
Corps (NavMed HC-4) - Modification of in Part. 

Refs: (a) BuMed Circ. Ltr M-6, Receipt, Transfer, and Disposition Card 
(NavMed HC-3), Preparation and Submission of, of 13 May 1944; 
AS&SL Jan-Junel944, 44-552, p. 374. 

(b) BuMed Circ. Ltr M-7, Roster Report of the Hospital Corps (Nav- 
Med HC-4), Preparation and Submission of, of 13 May 1944; AS&SL 
Jan-Jun 1944, 44-55,3, p. 379. 

1 . Reference (a) is hereby modified as follows: 

(a) Paragraph 2(d)(9) add subparagraph 2(d) (9) (SS): 
"Change of status to limited duty ashore". 

Cb) Paragraph 2 (instructions regarding numbered lines): 
Line 9, delete present list of technical specialties and substitute there- 
for as follows: 

Aviation Medicine 
Clerical Procedures 
Clinical Laboratory Technology 
Deep Sea Diving 
Dental Technology General 
Dental Technology Prosthetic 
Dermatology and Syphilology 
Duplication Technic 

Electrocardiography & Basal Metabolism 











- 34 - 

Burned News Letter, Vol. 5, No. 11 


Epidemiology and Sanitation 


E le ctr oencep hal ogr aphy 


Fever Therapy 


Low Pressure Chamber 




Medical Field Service 


Medical Photography 




Neuropsychiatry Clerical Procedures 


Occupational Therapy 


Operating Room Technic 


Pharmacy and Chemistry 


Submarine Service 


Physical Therapy 


Property and Accounting 




X-Ray & Photofluorography 


Line 10, delete present list of special qualifications and substitute there- 
fore as follows: 


Dental Repairman 
Medical Illustrator 
Orthopedic Appliance Mechanic 
Chemical Warfare 
* Dental Technician Prosthetic 
Podiatrist (Chiropodist) 
Radium Plaque Adaptometer Operator 
Registered Pharmacist 
Sound Motion Picture 
Acrylic Eye Illustrator 
Spectacle Dispensers 
Physical Education 

*(DP) is a designator and is specifically authorized by BuPers as an integral 
part of rate of pharmacist's mates who were in general previously qualified and 
designated DPT (see BuPers CirLtr 214-44). 

2. Reference (b) is hereby modified as follows: 

(a) Paragraph 2(d) (3) , delete present list of technical specialties and substi- 
tute therefore the list of technical specialties as modified in paragraph 1 above. 

(b) Paragraph 2(e)(7), column V: Remarks - delete etc., at end of paragraph 
and add "Limited duty ashore" etc. — BuMed. Ross T. Mclntire. 


POD • 

- 35 - 

Burned News Letter, Vol. 5, No. 11 


To: All Ships and Stations. Pers-66-McG 


Subj: Policy Regarding Disposition of Partially Disabled BuMe d-RP -1MB 
Enlisted Men of the Naval Service. P16-3/P3-2 

30 Apr 1945 

Refs: (a) BuMed-BuPers joint ltr of 28 Oct 1942; N. D. Bui. Cum. Ed. 1943, 
42-923, p. 1162. 

Cb) BuMed-BuPers joint ltr BuMed-RP-OIM, Pers-66-WH-P2-5, of 
3 Mar 1945; N. D. Bui. of 15 Mar 1945, 45-265. 

(c) BuPers-BuMed joint rest, ltr Pers-66-ELH, BuMed-RP-OIM, of 
12 Jan 1945, as corrected by BuPers-BuMed joint ltr BuPers P3-5-66- 
WH, BuMed-RP-OIM, of 22 Feb 1945, addressed only to MOINC, U. S. 
Naval and U. S. Naval Convalescent Hospitals, Continental U. S. 

(d) BuPers-BuMed joint ltr BuPers 6303-DW, P16-3/NH, BuMed-Rl- 
JLA, P16-3/NHC034), of 30 Mar 1944; AS&SL Jan-Jun 1944, 44-405, p. 741. 

1. References (a) and Cb) are hereby canceled. 

2. Enlisted personnel who are considered to be not physically qualified for all 
the duties of their rating shall be brought before a board of medical survey for 
evaluation of their physical condition and recommendation as to disposition. 

If they are found by a board of medical survey to be not physically qualified 
for all the duties of their rating, they shall be recommended for discharge 
except in the cases set forth below: 

(a) Men whose disabilities are the result of wounds received in action or 
disease incurred in, and peculiar to, combat areas (such as filariasis and 
malaria). At their option, these men may be retained on active duty and as- 
signed to duty commensurate with their physical qualifications in a limited- 
duty status; or if they so request in writing, be discharged from the naval 
service. Those who are Fleet Reservists or retired enlisted men may be re- 
leased to inactive duty if they so desire and so request in writing. 

(b) Men who present the disability seasickness (motion sickness) shall not 
be discharged but classified as physically qualified for duty on shore, including 
foreign shore, and transferred to nearest appropriate receiving station for 
assignment as follows: Receiving stations east of Mississippi River for further 
assignment by Commander Service Force, Atlantic Fleet, Subordinate Command; 
receiving stations west of Mississippi River for further assignment by Com- 
mander, Western Sea Frontier. 

(c) Men who are not physically qualified for. general service but who meet 
the physical standards for induction into the Navy as "Special Assignment" 
and are otherwise qualified for retention in the naval service, shall not be dis- . 
charged but retained in the naval service and their classification changed to 
"Special Assignment" by adding (SA) following the designation USN, USN-I, 
USN(SV), USNR, or USNR(SV), as applicable, and they shall be assigned to 

duty in accordance with provisions of BuPers Circular Letter 8-45, of 15 Jan 
1945. Minimum physical standards for men classified "Special Assignment" 

- 36 - 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 

differ from general -service standards as follows: (a) Color perception - 
color blindness acceptable, (b) vision - minimum 2/20 if correctible to 10/20 in 
each eye. Will accept slight functional defects, <c) hearing - 8/15 acceptable in 
each ear. 

(d) Men who are temporarily unfit to perform all the duties of their rating 
by reason of combat or operational fatigue. These cases are considered to 
have a fatigue state or condition which has developed as a consequence of com- 
bat conditions and shall be recommended for return to duty, either limited or 
unlimited as circumstances warrant. Such cases shall not be discharged from 
the service under this diagnosis. If such an individual is totally unfitted for 
service a diagnosis more nearly representative of the basic disability shall be 

3. It is directed that the medical officer in command, U. S. naval hospitals 
and naval convalescent hospitals (continental U. S.) , take final action on the 
report of. medical survey where discharge is recommended and such action can 
be taken in accordance with the authority contained in ref. (c) . Otherwise, the 
report of medical survey shall be forwarded to this Bureau via BuMed for dis- 

4. In accordance with, the provisions of this letter the only men to be retained 
for limited duty by reason of physical disability are, those partially disabled 
by reason of wounds received in action or disease incurred in, and peculiar to, 
combat areas (malaria, filariasis, combat or operational fatigue); seasickness 
cases; and those who meet the physical standards for induction as "Special 
Assignment" personnel. These partially disabled men, if retained on active 
duty, shall: 

(a) Be eligible for advancement in rating. 

(b) If Regular Navy men, be eligible for transfer to the Fleet Reserve upon 
completion of required service in accordance with existing legislation. 

(c) If Regular Navy men, not to be discharged at expiration of enlistment 
with a view to immediate reenlistment, until waiver of the physical defect has 
been approved by the Bureau of Naval Personnel. 

(d) If they become unable to perform their duties, or when their services 
• are no longer required, be brought before a board of medical survey for re- 
port and recommendation as to disposition. 

(e) Be reexamined upon own request, and in any event reexamined every 
six months (ref. (d)), with a view to restoration to a full-duty status. 
--BuPers. W. M. Fechteler. --BuMed. Ross T. Mclntire. 


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Burned News Letter, Vol. 5, No. 11 



All Ships and Stations. 



30 Apr 1945 


Enlisted Personnel Classified as Fit for Limited 
Duty Only as a Result of Medical Survey or Nav- 
Med Form Y, Disposition in the Case of. 

Refs: (a) BuPers-BuMed joint rest. Itr Pers-66-ELH, BuMed-RP-OIM, of 

12 Jan 1945, as amended by BuPers-BuMed joint ltr Pers P3-5/66-WH, 
BuMed-RP-OIM, of 22 Feb 1945, addressed to MOINC All U. S. Naval 
Hospitals and Naval Convalescent Hospitals (Continental U. S.) . 
(b) Par. 1529, Manual of the Medical Department. 

Cc) Joint Regulations of the Secretary of War, the Secretary of the Navy, 
and the Administrator of Veterans' Affairs to Implement Sections 103 
and 200 of the Servicemen's Readjustment Act of 1944 - Instructions 
for Complying with - of 10 Aug 1944; N.D. Bui. of 31 Aug. 1944, 44-960. 
(d) BuPers-BuMed joint ltr BuPers 6303-DW, P16-3/NH, BuMed-Rl- 
JLA, P16-3/NH(034), of 30 Mar 1944; AS&SL Jan-Jun 1944, 44-405, p. 741. 

1. By 1 November 1945 it is desired that substantially all enlisted personnel who 
have previously been classified as fit for limited duty only as the result of an ap- 
proved report of medical survey or NavMed Form Y be discharged or released 
to inactive duty. To accomplish this the following procedure shall be followed: 

(a) All such personnel shall be reexamined. However, in order not to im- 
pair the operating efficiency of an activity to which a large number of limited- 
duty personnel are now assigned, such reexaminations shall be conducted pro- 
gressively during the 4 months following receipt of this letter. 

(b) Administrative commands, commanding officers, and medical officers 
should critically appraise the ability of men in this category to perform all the 
duties of their respective ratings. It is desired that care be exercised in inter- 
pretations of physical fitness for full duty giving due attention to the individual's 
age, rate, service experience, mental attitude, etc. It is particularly important 
that men not be returned to a full-duty status where they might be sent to sea 
or foreign shore duty if their physical condition is such that they are unlikely 

to render full service in their rating. 

(c) Should examination result in the determination that a man is physically 
qualified for all the duties of his rating, appropriate entry shall be made in the 
health record NavMed Form H-8 in duplicate and a copy of such entry forwarded 
to BuMed. An appropriate entry shall also be made on page 9 of the man's service 
record citing this letter as authority and the duplicate copy forwarded to BuPers. 
The man concerned shall then be transferred to the nearest receiving ship or 
receiving station for general detail. The provisions of paragraph 8 of reference 
(d) are modified accordingly. 

(d) Those enlisted men who are found not physically qualified for full duty 
shall be brought before a board of medical survey before discharge or release 
from active duty in accordance with the provisions of reference (b). This is 
particularly important in view of the Veterans' Administration benefits, the 

38 - 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 

income-tax benefits, and the other services provided which relate to rehabili- 
tation, civil readjustment, and reemployment of disabled or partially disabled 
ex-servicemen. It is desired that, whenever possible, these men appear before 
a board of medical survey at their station of duty. This shall not preclude 
hospitalization of those individuals currently in need of hospital treatment, or 
of those who require special rehabilitation measures because of physical disa- 

(e) Those individuals who are retained at their duty stations for medical 
survey may be returned to limited duty while awaiting the final action by the 
Bureau of Naval Personnel upon the Report of Medical Survey. In the event 
their discharge from the service by reason of physical disability is directed 
by the Bureau of Naval Personnel, commanding officers concerned shall carry 
out all required naval procedures with a view that such individuals may derive 
all the benefits to which they are entitled from the Veterans' Administration, 
such rehabilitation as the individual may need, and such social, vocational, and 
reemployment adjustments as may be warranted. (Reference should be made 
to reference (c) .) 

2. Enlisted personnel found by a board of medical survey to be not physically 
qualified for all the duties of their rating shall be recommended for discharge 
except in the cases set forth below: 

(a) Men whose disabilities are the result of wounds received in action or 
disease incurred in, and peculiar to, combat areas (such as filariasis and 
malaria) . At their Option, these men may be retained in the naval service 
on active duty for the convenience of the Government and assigned to limited 
duty commensurate with their physical qualifications. However, if they so 
request in writing, they may be discharged from the naval service. Fleet 
Reservists and retired enlisted men may similarly be released to inactive 

(b) Men who present the disability seasickness (motion sickness) shall 
not be discharged but classified as physically qualified for duty on shore, in- 
cluding foreign shore, and transferred to nearest appropriate receiving station 
for assignment as follows: Receiving stations east of Mississippi River for 
further assignment by Commander Service Force, Atlantic Fleet, Subordinate 
Command; receiving stations west of Mississippi River for further assignment 
by Commander, Western Sea Frontier. 

(c) Men who are not physically qualified for general service but who meet 
the physical standards for induction into the Navy as "Special Assignment" 
and are otherwise qualified for retention in the naval service, shall not be dis- 
charged but retained in the naval service and their classification changed to 
"Special Assignment" by adding (SA) following the designation USN, USN-I, 
USN (SV), USNR, or USNR (SV), as applicable, and they shall be assigned to 
duty in accordance with the provisions of BuPers Circular Letter 8-45, of 15 
Jan 1945. Minimum physical standards for men classified "Special Assign- 
ment" differ from general -service standards as follows: (a) Color perception - 

- 39 - 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 

color blindness acceptable, (b) vision - minimum 2/20 if correctible to 10/20 
in each eye. Will accept slight functional defects, (c) hearing - 8/15 acceptable 
in each ear. 

(d) Men who are temporarily unfit to perform all the duties of their rating 
by reason of combat or operational fatigue. These cases are considered to 
have a fatigue state or condition which has developed as a consequence of com- 
bat conditions and shall be recommended for return to duty, either limited or 
unlimited as circumstances warrant. Such cases shall not be discharged from 
the service under this diagnosis. If such an individual is totally unfitted for 
service a diagnosis more nearly representative of the basic disability shall 
be established. 

3. The report of medical survey in the cases of enlisted personnel surveyed 
at their station of duty shall be forwarded to BuPers via BuMed for final 
action. However, when surveyed at a naval hospital or naval convalescent hos- 
pital within the continental U. S., final action on the report of medical survey 
may be taken by the medical officer in command when discharge is recommended 
and such action can be taken in accordance with the authority contained in ref- 
erence (a). 

-- BuPers. W. M. Fechteler. --BuMed. Ross T. Mclntire. 

# + ;(e ^! >(; 

To: All Ships and Stations. Pers-312B/lh 

PI 6- 3/00 

Subj: Officers Unable to Continue Duty because of Chronic BuMed-RP-DMA 
Seasickness, Reassignment of. A11/P3-1 

30 Apr 1945 

Refs: (a) BuPers Circ. Ltr 133-44; AS&SL Jan-Jun 1944, 44-568, p. 567. 

(b) BuPers Circ. Ltr 69-42; N. D. Bui. Cum. Ed. 1943, 42-2122, p. 626. 

1. Hereafter, commanding officers or reporting seniors will issue written 
orders (copy to BuPers) detaching the subject officers from their duty stations 
and directing them to report to the nearest naval hospital, dispensary, or other 

, medical activity for observation. This letter should be referenced as authority 
for such orders. Medical officers in command of medical activities which do 
not have adequate facilities for complete examination of such officers are 
authorized to transfer them to the nearest activity where an adequate examina- 
tion can be made . 

2. After examination and appropriate medical study, the subject officers will ' 
be brought before a board of medical survey and upon forwarding of the report 
will be disposed of as follows: 

(a) Those requiring further hospitalization will be retained for treatment 
or transferred as necessary. 

- 40 - 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 

(b) Those fit for return to duty, if the hospital is outside the continental 
limits, will be discharged from the sick list and issued written orders (copy 
to BuPers) directing them to report to the area commander for assignment 
to duty consistent with their disability. The area commander will dispose of 
these cases as follows: 

CI) Those officers who are fit for sea duty on a large ship will be re- 
ported by dispatch to BuPers as available for such assignment, citing this 
letter as reference. 

(2) Those who are fit for assignment to shore duty only will be issued 
written orders (copy to BuPers) by the area commander directing them to 
report to a shore station within the area - or will be reported to BuPers by 
dispatch as available for assignment to shore duty and not required within, 
the area, citing this letter as reference. 

(c) Those fit for return to duty, including limited duty, if the hospital is 
within the continental limits, will be. disposed of under the authority granted 
by reference (a) . 

3. In all cases, medical officers in command will indicate, as a part of the 
endorsement on the report of medical survey, the disposition of the officer 
covered by the survey report. 

4. Except as provided under 2(a) above, reference (b) may no longer be con- 
sidered authority to transfer the subject officers to the United States. 
--BuPers. W. M. Fechteler. --BuMed. Ross T. Mclntire. 



To: All Ships and Stations. Aer-TF-22-EAT 


Sub i: Navy Training Films , Change in Security Classification 

5 Apr 1945 

Ref: (a) CNOltr Op-33-J9-jDK, serial 132733, of 21 Mar 1945. 

1 . Attention is invited to the following training film security classification 
changes authorized by reference (a): 

From confidential to restricted 

MN-2361 G and You 
From restricted to nonclassified 

MN-3446 ABC of G 

— BuAer. L. B. Richardson. 

- 41 - 

Burned News Letter, Vol. 5, No. 11 RESTRICTED 


To: All Ships and Stations. BuMed-WH-ERT 


Subj: Patient's Identity Tag, Use of. 16 Apr 1945 

End: (A) Patient's Identity Tag. 

1. The Patient's Identity Tag, NavMed Form 70, shall be used for drafts of 
patients. The tags are printed on orange, green, and white cards and may be 
used to. designate patients by branch of service. 

2. The following classification has been established for uniformity of handling 
patients of all services: 


STRICT MENTAL. These patients (major psychotics) will 
require the equivalent to locked ward accommodations on 
returning ships, hospital train or plane and at final destina- 
tion, and will require, special attendants. 
SECURITY MENTAL. These patients require locked ward 
accommodations aboard returning ships and hospital trains 
or plane. 

OPEN WARD MENTAL. These patients may be accommodated 
similarly to hospital ambulant and troop class patients. 

HOSPITAL AMBULANT. These patients are ambulant, but 
require medical services from other individuals. 
TROOP CLASS (AMBULANT). These patients do not re- 
quire hospital care enroute and can take care of themselves. 

3. Each tag is divided into five sections, with the serial number of the tag on 
each section. The five sections are: 

(a) Patient's Identification Tab 

(b) Debarkation Tab 

(c) Record Office Tab 

(d) Embarkation Tab 

(e) Baggage Tab 

The embarking activity shall, in each case, have the tags properly and legibly 
completed and attached to the patient at the time of embarkation. The diag- 
nosis shall not be entered on patient with neuropsychiatric disturbances or 
venereal diseases. The baggage tab shall be attached to one piece of the. pa- 
tient's baggage and each additional item identified with the name, rank or rat- 
ing, serial or service number and tag number. The embarkation tab will be 
detached by the embarking activity and used as a check on the patient embarked. 

Class 1A 

Class IB 

Class 1C 

Class 2 
Class 3 

Class 4 

- 42 - 

Burned News Letter, Vol. 5, No. 11 


As patients board ship, train or aircraft, the record office tab shall be detached 
and filed in the office of the medical department for identification, diagnosis, 
and location of the patient. The record office tab may also be used as a check 
against the embarkation roster. The debarkation tab may be used aboard ship, 
train or aircraft for the location of the patient and should be collected at de- 
barkation. Before debarkation the remaining part of the tag should again be 
attached to the patient. 

4. These forms may be obtained from the Naval Medical Supply Depot, Brook- 
lyn, New York, or Oakland, California, and will be listed in the Supply Catalog 
of the Medical Department as follows: 

Stock No . 
SI 6 -2040 



Patient's Identity Tag (green) 
Patient's Identity Tag (orange) 
Patient's Identity Tag (white) 

--BuMed. Ross T. Mclntire. 




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